Satomi Sugiyama

A Case of Bilateral Submandibular Gland Stones in a Child

Sialolith commonly occurs unilaterally in the submandibular gland of adults, while submandibular gland stones occur rarely in children. Here we report a case of bilateral submandibular gland stones in a child. A 7-year-old boy had swelling of the left submandibular gland. The patient was referred to our department for endoscopic removal to avoid submandibular gland removal after bilateral hilar stones of the submandibular gland had been diagnosed in another hospital. Because the left stone, 1.7×1.7×1.1mm in size, was located at the orifice of the papilla at the first visit, the stone was removed under local anesthesia. But, the right stone, 3.0×1.6×1.5mm in size, was located at the hilar, and the patient was followed up. Eight months after the initial visit, the patient had swelling of the right submandibular gland. Because the right stone was located at the orifice of the papilla, the right stone was removed under local anesthesia. There was no recurrence after the removal of submandibular gland stones.

Facial nerve paralysis after super-selective intra-arterial chemotherapy for oral cancer

Facial nerve paralysis (FNP) after super-selective intra-arterial chemotherapy (SSIAC) is a relatively rare local side effect of SSIAC to the maxillary artery (MA) or the middle meningeal artery (MMA). The incidence and prognosis of FNP after SSIAC in 381 patients with oral cancer (133 with catheterization of the MA, 248 without) was investigated retrospectively. Only three patients (two male and one female) had FNP, for an incidence of 0.8%. All patients with FNP had undergone catheterization of the MA, and the incidence of FNP in this group was 2.3% (3/133). One of the three patients with FNP had paralysis of the third branch of the trigeminal nerve. FNP occurred a mean of 8.7 days (range 5-11 days) after initial SSIAC, and the mean total dose of cisplatin was 55.8mg (range 42.5-67.2mg) and of docetaxel was 25.4mg (range 17.0-33.6mg). FNP resolved completely a mean of 12.7 months (range 6-19 months) after onset. Because the administration of anticancer agents via the MA or MMA carries a risk of FNP, this information will be useful when obtaining informed consent from patients before treatment.

Sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland

Obstructive sialadenitis of the submandibular gland is commonly caused by sialoliths, but more rarely by foreign body-induced sialoliths. Here, we report minimally invasive sialendoscopic removal of fish bone-induced sialoliths in the duct of the submandibular gland. A 43-year-old woman presented with recurrent swelling of the right submandibular gland at other hospital. Computed tomography (CT) showed an 8-mm linear calcification in the posterior part of Whartons duct. The lesion was deemed difficult to remove and she was followed up. However, because the lesion did not resolve spontaneously within 9 months and chronic sialadenitis symptoms persisted, she was referred to our department for endoscopic removal. CT showed a linear calcification (5.6×1.2×0.8mm) connecting 2 spherical calcifications (2.3×2.1×1.9mm; 1.8×1.4×1.1mm) in the anterior part of Whartons duct. The patient underwent endoscopic removal of the lesion using a 1.6-mm-diameter sialendoscope under local anesthesia. The specimen contained a fish bone connecting 2 sialoliths. The patient was unaware of the fish-bone injury. After removal, there was no recurrence of submandibular gland swelling during 6 months follow-up.